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Anemia after bariatric surgery: more than just iron deficiency.
Nutr Clin Pract 2009 Apr-May; 24(2):217-26NC

Abstract

Bariatric surgery for morbid obesity is rapidly gaining popularity. Restrictive and/or malabsorptive surgical interventions result in dramatic weight loss with significantly decreased obesity-related morbidity and mortality. Anemia, which may affect as many as two-thirds of these patients, is of concern and generally thought to be caused by iron deficiency. Although iron deficiency in this population may be frequent given pouch hypoacidity, defunctionalized small bowel, and red meat intolerance, it may not account for all anemias seen. First, there is increasing evidence that obesity creates a state of chronic inflammation. Both iron deficiency anemia and anemia of chronic inflammation present with low serum iron levels. Most studies reporting anemia after bariatric surgery lack serum ferritin determinations so that the relative contribution of inflammation to anemia cannot be assessed. Second, a significant number of anemias after bariatric surgery remain unexplained and may be attributable to less frequently seen micronutrient deficiencies such as copper, fatsoluble vitamins A and E, or an imbalance in zinc intake. Third, although deficiencies of folate and vitamin B(12) are infrequent, study observation periods may be too short to detect anemia attributable to vitamin B(12) deficiency because vitamin B(12) storage depletion takes many years. This review is intended to increase awareness of the mechanisms of anemia above and beyond iron deficiency in the bariatric patient and provide healthcare providers with tools for a more thoughtful approach to anemia in this patient population.

Authors+Show Affiliations

VA San Diego Healthcare System, La Jolla Medical Center, 3350 La Jolla Village Dr, 111E, San Diego, CA 92161, USA. avondrygalski@ucsd.eduNo affiliation info available

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

19321896

Citation

von Drygalski, Annette, and Deborah A. Andris. "Anemia After Bariatric Surgery: More Than Just Iron Deficiency." Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition, vol. 24, no. 2, 2009, pp. 217-26.
von Drygalski A, Andris DA. Anemia after bariatric surgery: more than just iron deficiency. Nutr Clin Pract. 2009;24(2):217-26.
von Drygalski, A., & Andris, D. A. (2009). Anemia after bariatric surgery: more than just iron deficiency. Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition, 24(2), pp. 217-26. doi:10.1177/0884533609332174.
von Drygalski A, Andris DA. Anemia After Bariatric Surgery: More Than Just Iron Deficiency. Nutr Clin Pract. 2009;24(2):217-26. PubMed PMID: 19321896.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anemia after bariatric surgery: more than just iron deficiency. AU - von Drygalski,Annette, AU - Andris,Deborah A, PY - 2009/3/27/entrez PY - 2009/3/27/pubmed PY - 2009/5/8/medline SP - 217 EP - 26 JF - Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition JO - Nutr Clin Pract VL - 24 IS - 2 N2 - Bariatric surgery for morbid obesity is rapidly gaining popularity. Restrictive and/or malabsorptive surgical interventions result in dramatic weight loss with significantly decreased obesity-related morbidity and mortality. Anemia, which may affect as many as two-thirds of these patients, is of concern and generally thought to be caused by iron deficiency. Although iron deficiency in this population may be frequent given pouch hypoacidity, defunctionalized small bowel, and red meat intolerance, it may not account for all anemias seen. First, there is increasing evidence that obesity creates a state of chronic inflammation. Both iron deficiency anemia and anemia of chronic inflammation present with low serum iron levels. Most studies reporting anemia after bariatric surgery lack serum ferritin determinations so that the relative contribution of inflammation to anemia cannot be assessed. Second, a significant number of anemias after bariatric surgery remain unexplained and may be attributable to less frequently seen micronutrient deficiencies such as copper, fatsoluble vitamins A and E, or an imbalance in zinc intake. Third, although deficiencies of folate and vitamin B(12) are infrequent, study observation periods may be too short to detect anemia attributable to vitamin B(12) deficiency because vitamin B(12) storage depletion takes many years. This review is intended to increase awareness of the mechanisms of anemia above and beyond iron deficiency in the bariatric patient and provide healthcare providers with tools for a more thoughtful approach to anemia in this patient population. SN - 0884-5336 UR - https://www.unboundmedicine.com/medline/citation/19321896/Anemia_after_bariatric_surgery:_more_than_just_iron_deficiency_ L2 - https://doi.org/10.1177/0884533609332174 DB - PRIME DP - Unbound Medicine ER -